Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation
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Published on: February 5, 2019
Fanny Söderström1, Erik Normann2, Maria Jonsson2
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden fanny.soderstrom@kbh.uu.se.
Insights
An active management approach for extremely preterm infants born at 22-24 weeks gestation shows promising survival rates and favorable neurodevelopmental outcomes. Most infants were unimpaired by 2.5 years, indicating this strategy does not increase long-term adverse neurological issues.
Area of Science:
- Neonatalogy
- Perinatology
- Developmental Pediatrics
Background:
- Extremely preterm infants (22-24 weeks gestation) face significant survival and morbidity challenges.
- Management strategies for this vulnerable population are critical for optimizing outcomes.
Purpose of the Study:
- To evaluate survival and neurodevelopmental outcomes in infants born at 22-24 weeks gestation.
- To assess the impact of a uniformly active management approach on extremely preterm infants.
Main Methods:
- Retrospective cohort study of infants born between 2006-2015.
- Assessment of short-term morbidities including ROP, NEC, PDA, IVH, PVL, and BPD.
- Evaluation of neurodevelopmental outcomes: CP, visual/hearing impairment, and developmental delay at 2.5 years corrected age.
Main Results:
- Overall survival was 64%, with rates from 52% (22 weeks) to 70% (24 weeks).
- At 2.5 years, 34% of survivors had neurodevelopmental impairment; 11% were moderately to severely impaired.
- Lower gestational age correlated with increased rates of ROP, severe BPD, visual impairment, and developmental delay.
Conclusions:
- A uniformly active management approach yields comparable survival rates across 22-24 weeks gestation, with over 50% survival at 22 weeks.
- The majority of survivors were unimpaired at 2.5 years, suggesting this approach does not lead to increased long-term adverse neurological outcomes.
Objective:
To determine survival and outcomes in infants born at 22-24 weeks of gestation in a centre with a uniformly active approach to management of extremely preterm infants.
Study Design:
Single-centre retrospective cohort study including infants born 2006-2015. Short-term morbidities assessed included retinopathy of prematurity, necrotising enterocolitis, patent ductus arteriosus, intraventricular haemorrhage, periventricular malacia and bronchopulmonary dysplasia. Neurodevelopmental outcomes assessed included cerebral palsy, visual impairment, hearing impairment and developmental delay.
Results:
Total survival was 64% (143/222), ranging from 52% at 22 weeks to 70% at 24 weeks. Of 133 (93%) children available for follow-up at 2.5 years corrected age, 34% had neurodevelopmental impairment with 11% classified as moderately to severely impaired. Treatment-requiring retinopathy of prematurity, severe bronchopulmonary dysplasia, visual impairment and developmental delay correlated with lower gestational age.
Conclusions:
A uniformly active approach to all extremely preterm infants results in survival rates that are not distinctly different across the gestational ages of 22-24 weeks and more than 50% survival even in infants at 22 weeks. The majority were unimpaired at 2.5 years, suggesting that such an approach does not result in higher rates of long-term adverse neurological outcome.
